Dr. Vishal Patel

Bob Santos shares how TAVR helped defeat his aortic stenosis and saved his life — in more ways than one

Bob Santos, TAVR patient

Bob Santos at home, 2018.

Pancakes for breakfast the next day. Your results may vary, but that’s what Bob Santos had for breakfast the very next day after his transcatheter aortic valve replacement surgery (TAVR). Maybe we shouldn’t remind his interventional cardiologist, NCMA’s Dr. Patrick S. Coleman, about that.

If a rich, indulgent breakfast one day later sounds a bit out of the norm for a senior man that just had a major heart intervention, you’re right. But it does help underscore just how different a TAVR procedure can be from the more traditional open-heart (sternotomy) procedure.

Bob, himself, is a bit out of the norm, as far as heart patients go. At the time of his TAVR surgery, Bob was a robust 83 years old and, remarkably, “had never spent a night in the hospital” before. It’s not like Bob was an avoider of healthcare, either. He’s a medical man — a retired pediatric dentist of 40 years.

As Bob says, “I’ve just been so fortunate for so many years.” But that changed in mid-2017. After Bob’s remarkable run of good health, he began 2018 with three significant medical procedures during the span of five months. “I have really had a bit much,” he added.

As significant as Bob’s TAVR surgery was, it was perhaps the least taxing of the three in terms of recovery. He was diagnosed a few years back with aortic stenosis which is a progressive narrowing of his aortic heart valve that eventually would kill him if not corrected. In August of last year, his condition had progressed to the point where he was advised by Dr. Coleman to proceed with a screening process for transcatheter aortic valve replacement surgery.

After a bit of a delay due to the October wildfires, Bob completed his diagnostic scans in December and January. Says Bob: “The workup for the TAVR was really extensive — a lot of scans, a lot of pulmonary tests, and other different kinds of tests.”

“Frailty” was a concern. There was concern that Bob was too healthy — he needed to be deemed “frail enough” to qualify for Medicare to cover the TAVR procedure. As luck would have it, the extensive scans Bob endured in preparation for his TAVR surgery may have saved his life — in an unanticipated way.

“When they did the original … abdominal CT scan on me, they found a small cancerous tumor on my liver.” Bob explains, “That was a surprise for everyone. They were hopeful that it would be a hemangioma, which is a benign entity. They couldn’t verify that with the sonogram. They actually had to do a liver biopsy, which was an incredibly complex procedure. Because they have to go through your lung to get to this puppy.” Unfortunately, the scan revealed it was not a benign entity but a malignant tumor.

Fortunately, the tumor had not metastasized and was localized to about five percent of Bob’s liver. Dr. Brendan C. Visser of Stanford University Medical Center committed to perform a liver resection surgery on Bob. This meant two things: Bob now was “frail” enough to qualify for Medicare to cover the TAVR surgery. And he was about to need another major surgery — but it was going to have to wait. Bob’s narrowed heart valve presented too much of risk for liver surgery. His heart needed to be fixed before his cancer could be addressed. Bob’s liver resection would be the third of the three surgeries he was now facing.

Things kicked into high gear in February. “I had chemoembolization on February 6th. I had the TAVR procedure on February 14th.” That’s fast, but it was necessary to get Bob’s health needs addressed.

“After those two procedures, I could barely put one foot in front of the other. It was mostly the chemo that was really … I can’t speak as much as I would like to be able to about TAVR [alone]. It was complicated by the other procedure. [I was on] Plavix (clopidogrel) for two months. Then in mid-April, I had the resection of the tumor from the liver.”

After Bob’s difficult late-winter and spring, he’s got a new perspective on life. “Really, it’s serendipitous. They came up with the tumor diagnosis. If it had proceeded — particularly with organs like the liver and the pancreas — in 12 to 24 months I’d be toast. I mean talk about a lucky guy. I’m so fortunate. Because I am now cancer-free. I have a new heart valve. I can do so many things that I was not able to do.”

Which is good news for Riley.

Riley, Bob and Julia’s Sheltie of several years, was accustomed to a lot of daily “Bob” time. Before Bob’s aortic stenosis worsened, that usually consisted of morning walks of considerable length. Unfortunately, Bob’s aortic stenosis was cutting into Riley and Bob’s time. The walks got shorter and shorter, until they became too much.

“The significant [issue] with stenosis is being out of breath,” Bob explained. “There is just a demand on the large muscles, particularly in the legs, where they’re not getting enough oxygen.” This also meant Bob’s golfing buddies were about as unhappy as Riley.

Bob’s been an inveterate golfer since the age of 18 back in his days at Stanford University. “That became a limitation too. We went from 18 to playing nine. But when we’d play nine, we would pretty much walk and [carry clubs]. Eventually, we had to get into a cart. But even then, it was just too much demand.”

And after TAVR?

“[Things] changed dramatically, with TAVR. With this valve in place and with the ability for that left ventricle to pump blood into that aorta that gets to the rest of my body — it was just night and day. It’s just a whole different experience. It’s almost immediate, too. It’s not like it takes months for this to come into play. It is a very noticeable difference and change. This buys me some time.”

Bob’s enthusiasm for TAVR might be matched by his appreciation and understanding of the technical aspects of the procedure. He says, “I just can’t say enough about it. The approach is through the femoral arteries — just amazing technology. To go up, and make that curve, and to be able to place that valve, and the sizing of the valves and the placement of the valve are the key issues. … But they’re working with fluoroscopy. They know where they are. There is no guesswork here. It’s on a screen. It’s just absolutely incredible.

“They have two interventional cardiologists because the procedure is so technically demanding. [NCMA cardiologist Dr. Vishal] Patel works together with Dr. Coleman to safely deliver the stent. [NCMA cardiovascular surgeon Dr.] Keith Korver was there, who is the traditional surgeon in the event somehow this didn’t work out and they had to open me up. They have to be in one of these hybrid operatories so they can go from the catheter approach to a traditional surgical approach.”

In addition to making this successful series of three surgical procedures possible for Bob, the ability to recover and experience results quickly is what he values the most. For Bob, the symptoms of his aortic stenosis condition are now history after undergoing transcatheter aortic valve replacement.

“The symptoms pass almost immediately. I spent one night in the ICU. Pat thought perhaps I should spend one more night. We talked about it. … Some of the people that are having this procedure are perhaps even older, or more frail, with other medical situations, like diabetes. I didn’t have any of these other complications.”

Bob went home on the second day. “They stay at least two nights in the hospital to be sure they’re stable. But … I just can’t say enough about the whole combination of things. It has given me a new lease on life, really. I mean this has really bought me some time.

“I’m just a lucky guy — the right place and right time.”

Learn more

Here’s what you should know when you talk with your doctor about heart valve repair/replacement options: Transcatheter aortic valve replacement explained.


Get a free vein screening at NCMA Vein Center in Santa Rosa

Tired of achy legs & varicose veins?

For a limited time, you can get a free vein screening at NCMA Vein Center in Santa Rosa

legs of a mature woman with varicose veinsIf you’ve experienced leg discomfort, swelling or varicose veins, you may be at risk for venous reflux disease. NCMA Vein Center is here to help with screening and non-surgical treatment options for vein disorders.

We offer treatments that can have you feeling better quickly!

  • Office-based treatments
  • Rapid recovery
  • Covered by Medicare and most other insurance providers.

Call today for an appointment: 707-573-6199.


About NCMA Vein Center

NCMA’s Vein Center offers symptomatic venous disease treatment without hospitalization or surgery. Led by cardiologist Dr. Vishal Patel, we use the latest minimally invasive techniques and treat a full spectrum of venous disorders from varicose veins to severe venous stasis disease and ulcerations.

Learn more about our services online at NCMA Vein Center.

NCMA Vein Center

3536 Mendocino Avenue, Suite 200
Santa Rosa, CA 95403
707-573-6166 main
707-573-6199 scheduling
Fax: 707-573-6165

NCMA Announces Opening of the New Vein Center to Coincide with Launch of Website

Northern California Medical Associates (NCMA) opens the NCMA Vein Center and unveils a new website to provide patients with a full range of venous treatment options in Santa Rosa

NCMA Cardiologist and vein disease treatment specialist Dr. Vishal Patel along with Board Certified Cardiologist and Internal Medicine specialist Kimberly Brayton, MD are now offering state-of-the-art services for patients with venous disorders at The Vein Center. Located at 3536 Mendocino Avenue in Santa Rosa, this specialty clinic that is unique to Sonoma County provides advanced care for cardiovascular patients suffering from vein disorders such as varicose veins or venous reflux.

Along with a new clinic the Vein Center team has implemented a comprehensive website (ncmavein.com) that offers a full spectrum of resources and information at their fingertips. “To make our services easily accessible to the people of Santa Rosa, we wanted to create a website that offers an overview of the team and features comprehensive information about causes and symptoms,” explains Dr. Vishal Patel. “Along with articles that describe how cardiovascular health is related to vein disorders, website visitors can also read about available treatments and technology.”

The NCMA Vein Center is part of the expert cardiac and vascular care team utilizing current medical technology including the latest minimally invasive techniques and treatments for a full range of venous disorders. “NCMA is already the top local medical group in cardiac care, so it made sense to extend our leading-edge technologies along with our cardiac and vascular specialists into a specialty service line treating venous disorders,” explains Ruth Skidmore, NCMA’s CEO. “We developed our clinic to provide comprehensive diagnostics and treatments for all types of vein disorders without the need for lengthy hospital stays or extensive surgeries.”

Understanding Venus Reflux

Venous reflux occurs when the valves that keep blood flowing out of the legs and back to the heart become damaged or diseased. This can cause blood to pool in the legs and leads to symptoms including edema, skin changes and leg ulcers. Venous reflux disease commonly produces varicose veins which are abnormally swollen and discolored superficial leg veins.

“Without proper treatment, venous reflux can become quite debilitating,” explains Dr. Patel. “With treatment and active monitoring by our team of specialists, many of our patients experience dramatic symptom relief which makes it possible for them to return to activities that they might not have had the opportunity to enjoy prior to treatment.”

About Dr. Patel

Dr. Vishal Patel’s background as Director of the Vein Clinic began with board certification in interventional cardiology, cardiovascular disease, endovascular medicine and specialty certification with the American Registry for Diagnostic Medical Sonography Physicians’ Vascular Interpretation.  Vein disease treatment is Dr. Patel’s professional specialty and patient outcomes are extraordinary. Dr. Patel offers an informative video titled Evaluation and Management of Chronic Venous Diseases on the NCMA YouTube Channel available for free to view at any time.

About Dr. Brayton

Dr. Brayton is board certified in both internal medicine and cardiovascular disease. She received her medical degree and completed her Internal Medicine residency at the University of California, San Francisco and completed her clinical cardiology fellowship at UT Southwestern in Dallas, Texas, before transferring to Stanford University to complete her cardiology fellowship as well as receiving post-doctoral training including a master’s degree in health services research. Dr. Brayton continued on to complete a second post-doctoral fellowship at Stanford’s Clinical Excellence Research Center.

The NCMA Vein Center is geared toward putting patients on the path to long-term recovery. To request more information about venous reflux and to learn about the Vein Center team of providers visit the website or call (707) 573-6166.

The New Vein Clinic at NCMA and Dr. Vishal Patel Provide a Wide Range of Healing Options for Patients with Venous Disorders

Northern California Medical Associates is proud to provide patients with a full range of venous treatment options at their new Vein Clinic

Northern California Medical Associates (NCMA) announces a new service under the direction of cardiologist Dr. Vishal Patel for patients with venous disorders – The Vein Clinic. Utilizing the latest minimally invasive techniques and treatments for a full spectrum of venous disorders, this new specialty clinic is unique to the area and provides advanced care for patients. The Vein Clinic at NCMA is part of the expert cardiac and vascular care team utilizing leading-edge medical technology serving the North Bay.

Understanding Causes and Symptoms

veinsNearly 25 million people suffer from venous reflux in the U.S., a condition which causes varicose veins and other severe venous diseases including leg ulcers. Venous reflux disease, also referred to as venous insufficiency, is a condition that affects the circulation of blood in the lower extremities. Normally, one-way valves in the veins keep blood flowing toward the heart, counter to the force of gravity.  When the valves become weak and no longer close properly, they allow blood to flow backward, resulting in a condition called reflux.

While venous reflux itself may not be serious it can cause major discomfort and various complications. Symptoms often increase the risks of a wide variety of other chronic conditions. Many of the resulting diseases, such as thrombophlebitis can be quite serious. Without proper treatment, venous reflux can even become debilitating. With diligent treatment and monitoring however, many patients experience dramatic symptom relief.

Facts about Venus Reflux and Varicose Veins

Venous reflux tends to be more common in women than in men. According the latest statistics, it’s also more likely to occur in women between 40 and 49 and in men between 70 and 79. Inactivity, which includes sitting or standing for long periods of time, can result in high blood pressure in the leg veins and that increases a person’s risk of developing venous conditions. Other risk factors include:

  • smoking
  • cancer
  • muscle weakness
  • leg injury, or trauma
  • obesity
  • pregnancy
  • blood clots
  • family history of venous insufficiency

Venous reflux disease can produce a number of clinical problems for the patient and can significantly impact a person’s lifestyle.  In addition to being very painful, the more serious symptoms include edema, skin changes, venous ulcers – and venous reflux disease commonly produces varicose veins which are abnormally swollen and discolored superficial leg veins.

Treatment Options

walking legsThe Vein Clinic at NCMA offers several treatment options depending on severity. “Our new Santa Rosa clinic offers patients several treatment options including radiofrequency ablation (also known as Venefit or VNUS Closure), which represents a minimally invasive means of curing varicose veins and venous insufficiency,” explains Dr. Patel. “This treatment involves the use of radiofrequency energy, delivered through a catheter in a vein, to close the vein from the inside. Only a tiny incision in the leg is required for this procedure to be performed.” It is often done in the office using only local anesthesia and does not require a hospital stay. “Most patients find that the procedure is nearly painless, and the vast majority of patients are back to their usual routine by the next day,” he adds.

About The Vein Clinic and Dr. Patel

The Vein Clinic at NCMA is geared toward putting patients on the path to long-term recovery. The clinic provides comprehensive diagnostics and treatments for all types of vein disorders without lengthy hospital stays or extensive surgeries.

Dr. Vishal Patel’s background as Director of the Vein Clinic began with board certification in interventional cardiology, cardiovascular disease, endovascular medicine and specialty certification with the American Registry for Diagnostic Medical Sonography Physicians’ Vascular Interpretation.  Vein disease treatment is Dr. Patel’s professional specialty and patient outcomes are extraordinary. To request more information about venous reflux today call (707) 573.6166.

NCMA FountainGrove Cardiology Welcomes Vishal Patel, M.D.

Dr. Vishal Patel

Dr. Vishal Patel

Dr. Vishal Patel, M.D. is joining NCMA’s Fountaingrove Cardiology, an elite team of cardiologists who practice the most current, innovative treatments in cardiovascular medicine. Dr. Patel is board certified in interventional cardiology, cardiovascular disease, and endovascular medicine. He is certified board eligible in nuclear cardiology and certified
with the American Registry for Diagnostic Medical Sonography Physicians’ Vascular Interpretation. Dr. Patel is a recipient of the JoAnn McWhoter Award for Excellence in Clinical Cardiology and also received the St. Mary’s Medical Center
Outstanding Teaching Award.

Dr. Patel received his medical degree at Baylor College of Medicine in Houston,
Texas, and completed his residency in internal medicine at the University of
California at San Francisco, San Francisco, CA. Dr. Patel also pursued subspecialty
fellowship training in interventional cardiology and cardiovascular disease from the
University of Texas Southwestern Medical Center in Dallas, Texas.

When Dr. Patel is not working he enjoys spending time on outdoor adventures
with his wife, son, and new puppy. He loves to garden, cook, and explore the
Sonoma County food and wine scene.

3536 Mendocino Ave. Suite 200
Santa Rosa, CA 95403
To make an appointment with Dr. Patel call (707) 573-6199

Northern California’s premier provider of medical and surgical care since 1975
employing the most highly respected primary care physicians and specialists in
Sonoma, Lake and Mendocino Counties.